Judy Dercksen is a family physician and author in Quesnel, B.C.
I was at the tail end of my second round of handwashing when I heard Norah in the reception area.
“Please tell Judy I’m terribly sorry.” Her voice was an octave higher than usual.
I grabbed a paper towel from the dispenser and poked my head around the corner to greet her. Norah was one of my newer patients, in my practice for only five years. She handed a box of pastries to Lyndsay, my medical office assistant, and looked over at me.
“I missed my appointment. I’m so sorry,” she said. Her thinning reddish hair spun away from her tapering, anxious face. “I just don’t want you to fire me.”
Her overreaction to this minor lapse reflects the general climate of anxiety about family medicine in a country where millions of people struggle to find a primary care doctor and many more fear they may lose the one they have.
I’ve always loved family medicine, except for those moments – and in the time of the pandemic, weeks or months – when I hated it.
Signs of distress in family care medicine were clear before COVID-19, but the pandemic tore open the seams. The infection burden was only part of the problem.
As health care providers, we were bombarded with anxious patients clamouring for facts, for comfort, for assurances we were unable to provide. As the virus made itself known and people started to die, panic took hold. The brain doesn’t operate well in a state of panic. Thinking processes are affected. Judgment is impaired.
When hope arrived in the shape of vaccines, a large section of the populace was already disgruntled and fearful. They turned to outside sources for answers.
“What do you think about Ivermectin?” Gavin asked, a year into the pandemic. His hands gripped the leather armrest, his brown eyes studying my face intently as he waited for my answer.
“It’s an antiparasitic drug. COVID is a virus. It requires antiviral drugs and researchers are working hard to find–”
“There are studies showing it works against COVID. Why won’t the doctors use it if it works?” Frown lines creased his tanned forehead.
Why, indeed? A confederacy of doctors gleefully rubbing their hands together as they plot to withhold a drug from a vulnerable population? Preposterous. I qualified as a general practitioner in 1987 and completed my masters in family medicine in 1996. I study for hours every week. Yet a radio-show host’s fear mongering has more clout than my arguments.
I am quite sure I never once persuaded these patients of the difference between valid scientific research and unvalidated research, although a reluctant few finally agreed to be vaccinated. We were never taught negotiation skills in medical school. It would be a valuable addition to the curriculum.
Negotiation is a large part of being a doctor, such as teasing out the reasons that adopting a healthy lifestyle makes sense. If people quit smoking and drinking, and exercised more, we’d go a long way to relieving the family doctor crisis. Before that could happen, we have to work on mental health, a far stickier wicket.
Leading your patients to adopt the role of a patient-partner takes time. Time is our enemy.
We manage the comprehensive care of complex patients. The baby boomers are falling ill or suffering from chronic pain as they wait years for joint replacements. More patients are waiting to be placed in long-term care homes, their families banging on our doors, rightfully impatient to see their loved ones looked after.
We are responsible for managing acute conditions, chronic pain, cancer, disability, addictions, end-of-life care. The list goes on. After all these years, I still struggle to co-ordinate my patient visits. Add to that the burden of administration, and the reasons for family doctors leaving their practices are clear.
Forms will be our downfall. Spending hours on insurance papers, sick notes, pages and pages of return-to-work notes, disability forms, pension forms. Forms. Forms. Forms. Not to mention the hours a week we spend going over patient charts, laboratory, radiology and specialist reports. I feel my faith slipping.
And yet, while the work is emotionally and intellectually taxing, dear Lord, is it rewarding! Yes! That was never in question. The more work put in, the bigger the reward. Sure, there are days I want to tear my hair out, but fewer and fewer of them. Many of my patients have now been with me for all of the 20 years I’ve been a family doctor in Quesnel, B.C. They are family.
I’ve learned as a doctor to break the rules. I’ve learned sharing myself with my patients has improved our relationships, levelled the playing field. It has made patients more receptive to education. A well-informed patient is the most valuable tool in the tool box of health care.
This is what restores my faith. I believe in the strength of the human spirit. The ability of those damaged by childhood stress or adult trauma to heal. My patients have bolstered my belief system, proving themselves to be brilliant partners in their care.
Patients have taught me about diseases and life. They have taught me about myself. With nurturing, together, we strive for healthier lives.